Study Probes Care of Chronic Pain Patients Among Emergency Physicians


SAN FRANCISCO–Emergency physicians seldom see eye to eye with patients who seek help for chronic pain, according to preliminary results from a small, ongoing study.

The emergency physicians end up frustrated, and the patients seldom get the help they need, Scott M. Fishman, M.D., said at the annual meeting of the American College of Emergency Physicians.

The study recruits patients seen in the ED with a history of pain lasting 6 months or longer who already have been prescribed schedule II medications and who present with a vague complaint of pain in a body part or the whole body. They answer up to 13 questionnaires (as many as possible) and are asked to return within 2 weeks to complete the Structured Clinical Interview for DSM-IV (SCID) with a psychologist. The study also surveys the ED physicians and nurses treating the patients.

A comparison of answers from 39 patients who have completed the study at the halfway point of its 2-year schedule (out of 77 recruited so far) and answers from 54 providers showed significant disagreements on most topics, said Dr. Fishman, professor of anesthesiology at the University of California, Davis, and chief of pain medicine at the university's medical center.

Patients were more likely than providers to believe that chronic pain has little chance of improving, and to think that providers don't believe pain complaints if they lack physical or objective findings. Patients strongly disagreed that they were addicted to their pain medications, and providers were more ambivalent about patients' potential addictions. Patients feared the risk of dependence on opioids more so than did the providers.

All of these differences were significant between patients and providers as a whole, and between patients and either physicians or nurses.

On the Screener and Opioid Assessment for Patients in Pain (SOAPP) survey, nearly every patient scored positive for addiction, “staggering but early data” that raise the question of whether the SOAPP is valid in the ED, Dr. Fishman said.

Nine physicians so far interviewed at length described an emotional toll from caring for these patients.

“The words they used most commonly were frustrated, stressed, overwhelmed, nervous, and angry,” he said.

The physicians felt that chronic pain care is not appropriate for the ED. They were very concerned with differentiating “legitimate” pain from other complaints. Regardless, “almost everybody got a handful of Vicodin [hydrocodone] on the way out,” Dr. Fishman said.

“Is this treating the patient, or treating the physician?”

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